Application for
WSCC HONORS PROGRAM
710 Colegate Dr. Marietta, OH 45750
740.374.8716 www.wscc.edu
CONTACT INFORMATION
First name: Middle name: Last name (family name/surname): Sufx (Jr., III, etc.):
Social Security Number: E-mail address:
Street address:
City: County: State: Zip/postal code:
Cell phone:Work phone:Home phone:
PARENT/ GUARDIAN 1 INFORMATION (to be completed by students under 18 years)
HIGH SCHOOL INFORMATION
High school name: Graduation date:
City: State:
PLEASE LIST YOUR EXTRA CURRICULAR ACTIVITIES OR CURRENT INTERESTS:
First name: Middle name: Last name (family name/surname): Sufx (Jr., III, etc.):
E-mail address:
Street address:
City: County: State: Zip/postal code:
Cell phone:Work phone:Home phone:
GPA: Class Rank (if known): ACT Score (if applicable): COMPASS Score (if applicable): SAT Score (if applicable):
PARENT/ GUARDIAN 2 INFORMATION (to be completed by students under 18 years)
First name: Middle name: Last name (family name/surname): Sufx (Jr., III, etc.):
E-mail address:
Street address:
City: County: State: Zip/postal code:
Cell phone:Work phone:Home phone:
PLEASE LIST ANY SERVICE TO YOUR NEIGHBORHOOD OR COMMUNITY (i.e. Volunteering):